The biopsy specimen showed slight hyperplasia of the epidermis. Throughout a thickened sclerotic dermis, there was a nodular granulomatous infiltrate consisting of epithelioid histiocytes, lymphocytes, and occasional multinucleated giant cells surrounding degenerated hypereosinophilic collagen. Cholesterol clefts and calcification were present inside the granulomas. Lymphocytes and plasma cells were seen surrounding dilated blood vessels. The inflammatory process also involved the subcutaneous tissue. Transepidermal elimination of degenerated collagen and debris was seen. Stains were negative for fibrin and for acid-fast bacilli.